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. 2023 Oct 4;2023(10):CD004417. doi: 10.1002/14651858.CD004417.pub6

Dowell 2001.

Study characteristics
Methods Randomised controlled trial over 1 year
Participants 191 adults and children presenting with cough to 22 general practices in Scotland
99 participants were randomised to delayed antibiotics and 92 to immediate antibiotics
Age: the average age of participants in the delayed antibiotic group was 39.3 years, and in the immediate antibiotic group 43.8 years
Sex:delayed antibiotic group: 43 males, 56 females; immediate antibiotic group: 34 male, 58 female
Exclusion criteria: potential participants were excluded if the general practitioner would not consider offering antibiotics, or if the patient expressed a strong preference for antibiotics. Other exclusion criteria included people with chest signs, immunosuppression, pre‐existing lung disease, diabetes and patients who could not return to their general practice.
Interventions Participants were randomised to delayed antibiotics (script left at reception and participants instructed to pick up the script after 1 week of delay) or immediate antibiotics (antibiotic of general practitioner's choice)
Outcomes Baseline data were collected by the general practitioner. The participants were also asked to fill out a diary at home for 14 days regarding their symptoms.
Primary outcomes: outcome measures included duration of cough, fever, breathlessness, runny nose, antibiotic use and patient satisfaction
Notes The study was funded by a grant from the Royal College of General Practitioners
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Random number table
Allocation concealment (selection bias) Unclear risk Numbered envelopes (opacity not mentioned)
Blinding (performance bias and detection bias)
All outcomes Unclear risk Outcome assessor blinded. Blinding of participant and care provider not described.
Incomplete outcome data (attrition bias)
All outcomes Low risk Dropout numbers were described, and ITT analysis used. Of 191 participants, 148 returned questionnaires describing clinical outcomes and patient satisfaction.
Selective reporting (reporting bias) Low risk Prespecified clinical outcomes were not published, but authors provided this information
Other bias Low risk Funded by Royal College of General Practitioners